Real-time cardiovascular MRI and co-registration technical development

在过去的一年中，我们继续增强成像平台，以指导基于心血管导管的治疗。 其中包括与传统X射线共同配准的MRI，以及独立的实时MRI。 来自MRI数据集的静态3D路线图用于增强X射线心血管介入手术的图像引导，实际上已在本实验室用于开发新的治疗方法，如二尖瓣环扎成形术。 静态路线图不能准确表示心脏和呼吸运动期间的心血管解剖结构。 我们已经开发了一个系统来测量呼吸和心脏运动的实时MRI扫描，并推导出一组仿射模型，可用于跳动和呼吸的3D路线图覆盖在现场X射线。 我们还开发了强大的全自动数学技术来配准成像模式之间的基准标记。 我们将继续改进该系统的工作流程和可用性，以便它可以在日常基础上用于指导程序。 我们计划在未来几年将其系统地应用于儿科和成人导管插入术。 我们开发了一种自适应噪声消除系统，用于过滤MRI套件中射频和磁梯度场的干扰，并证明了在MR扫描期间检测心律失常的能力。 我们已将该系统扩展到完整的多电极导线表面和心内电描记图，以便在研究性MRI引导导管插入术期间将其集成到临床血流动力学记录系统中。 我们将继续改进该系统，以适应高风险的临床工作流程，包括MRI兼容的无线遥测系统。 我们使用面向游戏的图形处理单元提供的廉价并行计算资源来加速计算密集型MRI数据的重建。 我们已经成功地集成了非笛卡尔并行成像的交互式采集和重建设置，并证明了实时重建和可视化是可能的相对复杂的重建算法。 这已经与扫描仪软件集成，以允许与其他序列组件无缝组合。 我们已经开发了一个系统，为操作员提供多个同时表示的实时MRI数据平衡的时间和空间分辨率交互。 操作员选择所需的表示。 我们已经实现了黄金角实时MRI的时间分辨率的交互式选择。 我们正在将非常成功的本地实时MRI软件环境迁移到商业平台上，以促进NIH以外的翻译，并加强行业和大学的合作。这需要大量的开发来更新主力实时MRI脉冲序列，以促进快速多作者或多机构原型设计。 这一发展允许在技术专家而不是物理学家的工作人员支持下进行研究性人体MRI导管插入术，反映了一个完善的临床相关系统。 我们还将继续开发新的实时MRI方法，或设计实时MRI的本地非商业实施方案，以满足正在开发的程序的需求。

During the past year we have continued enhancement of imaging platforms to guide cardiovascular catheter based treatments. These have included co-registered MRI with conventional X-ray, as well as standalone real-time MRI. Static 3D roadmaps derived from MRI datasets are used to enhance image guidance for X-ray cardiovascular interventional procedures, and indeed have been used in this lab to develop novel treatments such as mitral cerclage annuloplasty. Static roadmaps do not accurately represent cardiovascular anatomy during cardiac and respiratory motion. We have developed a system to measure respiratory and cardiac motion from real-time MRI scans and to derive a set of affine models which can be used to beat and breath the 3D roadmaps overlaid on live X-ray. We also have developed robust fully automatic mathematical techniques to register fiducial markers between imaging modalities. We will continue to improve the workflow and usability of the system so that it can be used on a routine basis to guide procedures. We plan to apply this systematically to pediatric and adult catheterization procedures in the coming years. We have developed a system of adaptive noise cancellation to filter out interference from the radiofrequency and magnetic gradient fields in an MRI suite, and demonstrated the ability to detect arrhythmia otherwise obscured during MR scanning. We have expanded the system to full multiple lead surface and intracardiac electrograms, to integrated this into a clinical hemodynamic recording system during investigational MRI-guided catheterization. We will continue to enhance this system to accomodate high-risk clinical workflows, including an MRI-compatible wireless telemetry system. We have used inexpensive parallel computing resources afforded by game-oriented Graphics Processing Units to accelerate reconstruction of computationally-intensive MRI data. We have successfully integrated non-Cartesian parallel imaging in an interactive acquisition and reconstruction setup and demonstrated that real-time reconstruction and visualization is possible for relatively complicated reconstruction algorithms. This has been integrated with the scanner software to allow seamless combination with other sequence components. We have developed a system to provide the operator multiple simultaneous representations of real-time MRI data balancing temporal and spatial resolution interactively. The operator chooses the desired representation. We have implemented golden-angle real-time MRI with interactive selection of the temporal resolution. We are migrating our highly successful local real-time MRI software environment onto a commercial platform to facilitate translation outside of NIH, and to enhance industry and university collaboration. This has required considerable development to update workhorse real-time MRI pulse sequences to facilitate rapid multi-author or multi-institution prototyping. This development has allowed investigational human MRI catheterization to be performed with the staff support of a technologist rather than a physicist, reflecting a polished and clinically-relevant system. We also continue to develop new approaches to real-time MRI, or to engineer local noncommercial embodiments of real-time MRI to suit the needs of procedures being developed.